if you're running patients relatively dry you can do a hct and work out the EBL from the max allowable blood loss formula.

i like to transfuse right before the patients become symptomatic by anticipating likely changes. if i have a pt with ischemic CM i will not wait till patient is symptomatic. if i have a kid who is bleeding, i will transfuse before they become symptomatic - because once they're symptomatic they go downhill QUICKLY.

if you're running patients relatively dry you can do a hct and work out the EBL from the max allowable blood loss formula.

i like to transfuse right before the patients become symptomatic by anticipating likely changes. if i have a pt with ischemic CM i will not wait till patient is symptomatic. if i have a kid who is bleeding, i will transfuse before they become symptomatic - because once they're symptomatic they go downhill QUICKLY.

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What about the laps, drapes, floor, etc. Suction minus irrigation is not enough, IMHO.

What if you are not running them dry?

So when is "before they become symptomatic"? And why transfuse at all if they are healthy otherwise? I have seen Jehovah's Witness pts who have bled to a Hgb of 3 (Hct 9) who have survived without sequela. We currently have one in our ICU. She got down to 2.7 Hgb if I remember right after a MVA with multiple trauma. Maybe the little "sick" kids go downhill quickly but the healthy ones don't. They can take a hit and not miss a beat. Again, my opinion.

For CV cases, I don't even bother writing a number. Like copro said, if it's a big case with lots of blood loss, I'll just send an ABG and voila I know. Agree with the drapes hiding blood, especially the ones we use in OB for C-sxn's. You can never see it and the things must hold at least +/- 100 gallons (may be a slight overestimation).

I'm not sure about treating asymptomatic patients. If they are not symptomatic, why would you treat them?

ok, laps, drapes, etc. it's all reasonable. i think most EBL estimates are guesses at best.

if i'm not running them dry it's quite easy to estimate the diluted blood volume.

i give blood if hb is 7 (10 in ischemic CM) AND bleeding is ongoing.

many start transfusion when pts are hypotensive. this is WRONG. PRBCs are not meant to be used for IV volume expansion. theoretically, we should only give PRBCs if lactates go up or MVo2 goes down (CO is WNL).

as an aside, had a surgeon lose 3.5 L (clearly suction - irrigation) on a case. he argued he lost only 1.5 L. this DOES matter. a couple of hundred here and there don't make a difference, but 2L matters. he tried to make the reason for not extubating pt at the end of the case (she was in trend for 10 hours and got lots of volume) as "anesthesia volume overloading the patient." SORRY BUDDY - it's SURGICAL BLEEDING.

What about the laps, drapes, floor, etc. Suction minus irrigation is not enough, IMHO.

What if you are not running them dry?

So when is "before they become symptomatic"? And why transfuse at all if they are healthy otherwise? I have seen Jehovah's Witness pts who have bled to a Hgb of 3 (Hct 9) who have survived without sequela. We currently have one in our ICU. She got down to 2.7 Hgb if I remember right after a MVA with multiple trauma. Maybe the little "sick" kids go downhill quickly but the healthy ones don't. They can take a hit and not miss a beat. Again, my opinion.

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